Anatomic relationship between the hook of the hamate and the distal transverse carpal ligament

Terin T. Sytsma, Holly S. Ryan, Nirusha Lachman, Sanjeev Kakar, Jay Smith

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective During ultrasound-guided carpal tunnel release, osseous landmarks may supplement direct visualization of the distal transverse carpal ligament (dTCL) to ensure a complete release. The purpose of this study was to determine the relationship between the apex of the hook of the hamate (aHH) and the dTCL within the transverse safe zone (TSZ) of the carpal tunnel. Design Twenty unembalmed cadaveric specimens were dissected to determine the aHH-dTCL distance and the aHH-SPA distance (the distance between the aHH and the superficial palmar arch) at the ulnar and radial limits of the TSZ (the distance between the hook of the hamate or ulnar artery to the median nerve). Results The aHH-dTCL distance averaged 11-12 mm across the TSZ (maximum, 18.2 mm), whereas the aHH-SPA distance was significantly greater on the radial side of the TSZ compared with the ulnar side (22.6 ± 3.6 mm vs. 14.0 ± 4.0 mm). Conclusions The dTCL lies approximately 11-12 mm distal to the aHH across the TSZ, with an upper limit of 18.2 mm. Along with direct sonographic visualization of the dTCL, the aHH can be used with other osseous landmarks to estimate the position of the dTCL during ultrasound-guided carpal tunnel release.

Original languageEnglish (US)
Pages (from-to)482-487
Number of pages6
JournalAmerican Journal of Physical Medicine and Rehabilitation
Issue number7
StatePublished - Jul 1 2018


  • Carpal Tunnel Release
  • Carpal Tunnel Syndrome
  • Hamate Bone
  • Median Neuropathy
  • Transverse Carpal Ligament
  • Transverse Safe Zone
  • Ultrasonography

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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